ABA Therapy

About a year ago, my family was looking for a therapy for my brother that could reinforce academic skills outside of school and also help him with his homework. Seeing that our insurance covered ABA therapy, we decided to give it a try. It certainly seemed promising as polished therapists praised my brother’s potential, giving us new hope for his success in middle school that stretched for miles. It was eleven months later, however, that we finally decided to stop therapy after seeing that even after all this time, we had made no more progress than we had almost a year ago.

Why did this therapy go so badly for us? It may have been the specific ABA service we were with, whose head BCBA wasn’t the most willing to listen to her client’s concerns. Maybe it was even its therapists, most of whom did not have any initiative of their own and only listened to their boss. Despite those reasons, I feel that it was the essence of ABA therapy itself that made it so unappealing.

ABA therapy stands for “Applied Behavior Analysis,” its main goal being to change the client’s behavior with positive and negative reinforcement in order to emphasize “positive” behaviors and reduce “negative” behaviors. Sounds simple enough, right? It was these methods, however, that induced complacency in my brother, turning him into a robot that would seek to please the therapist’s needs instead of giving him any free will of his own. He was given strict “work” and “break” times, which were regulated by a timer. When the timer rang, he had to come back to the table to work again, and if he was late, he was usually given some sort of a minor punishment, usually a reduction in his next break time. This was how ABA seeked to reinforce behavior, by setting strict times in an effort to retain his focus because, apparently, the real world operates on a schedule.

Granted, focus has always been difficult for my brother, but what made captivating his attention even harder was the unengaging and repetitive work* he was given to do with his therapists. BCBA’s in ABA therapy are in charge of constructing “programs” for their clients, which consisted of a couple of goals such as “Name 5 foods that are crunchy” or “Name the planets in our solar system.” The same questions would be asked every couple of minutes in-between tasks for days on end – the infamous way ABA tends to reinforce behaviors. The problem was that after being asked the SAME EXACT questions for so long, my brother tended to memorize the answers and would just regurgitate the same answers whenever he was asked. Therapists did not ask any follow-up questions that would require him to think one step further. For example, in the case of the crunchy foods question, therapists could have asked him when he named a food whether it was sweet, healthy, etc., thereby leading him to question, learn more. Instead, they would only stick to what was required. (Again, this is perhaps not the fault of the therapists themselves who are simply following orders, but of the principle of ABA therapy itself.)

Another consequence of these questions being asked so frequently was that there were times that my brother would not answer simply because he was bored and because the therapists had failed to engage him through their yawn-evoking curriculum. A major flaw with the way ABA programs are regulated is that in order for a client to pass them and move onto the next one, all the questions must be answered with 80-90% accuracy within a specific program, and this testing occurs about once a month. Now, this may sound reasonably attainable, especially because the questions were being asked so frequently. It was the lack of engagement with the curriculum and his speech problem, however, that led my brother to not answer the questions every time, and in the BCBA’s eyes, this meant he had not “mastered” the program, leaving him in the same curriculum for yet another month.

Another flaw in ABA’s philosophy stems from its extensive use of data collection, which was done so often it overshadowed the therapy itself. Every time my brother sat down to do some work, the therapists would make a note of if he sat down, how long did he sit before he got back up, how many times he needed to be redirected, etc. on an iPad where they would check off the necessary checkboxes. It is not that this information is wholly un-useful, but rather that it was interfering with quality therapy time. Every month, the BCBA would present numbers such as “last month [my brother] only sat 65% of the time but this month he was able to 70% of the time!” on elaborate line graphs that would indeed, show us the massive improvement that they had been able to bring. Did this 5% increase really indicate an improvement of focus? Or had this been brought about by a slightly more interesting curriculum? Or I guess the better question is, does this even matter in the long run?

This is the point I would really like to bring across, is that no matter how much data is collected, it will mean nothing unless changes are brought about to address the data. For example, if there is a decrease in focus percentages, perhaps therapists should alter the curriculum, or try making break times longer. The point of data collection should be to learn from its trends and apply this knowledge to future programs; simply collecting data does not do anything.

Above anything else, the biggest problem I had with ABA therapy was that it took away my brother’s freedom and ability to think for himself. As a result of the token economy system**, he learned to live in fear of being punished and sought to satisfy the therapists as much as possible, which is exactly what they wanted to increase his “positive” behaviors. The way he was treated reminded me of how someone might train a dog, and it was quite heart-breaking to watch, especially when the therapists said that us family members were not allowed to interfere because the therapists were “trained” enough to handle the situation. If he ran down a hallway too fast, the therapist would count “3…2…1…” really loudly and threaten to take away a token until he came back and walked instead. They would do the same if he got up from the work table for even a moment to stretch. This was obviously really frustrating to him and as a result, he would get upset and start self-injurious behaviors. Upon seeing this, the therapists would do nothing and just tell him to calm down, because according to ABA, special needs children only engage in these behaviors because they know that they will get what they want. To me, this is appalling and shows a true lack of understanding of special needs, but to them, logical.

ABA therapy failed to stimulate my brother’s creativity, instead suppressing his wants and shaping him to be a compliant robot. I am thankful that we stopped the therapy when we did, because they were trying to make my brother fit a mold that he simply could not fit in.

There are many others today who are also questioning the merits of ABA therapy and whether it is more harmful than helpful in encouraging compliance rather than individuality. Check out this article below, written by an autistic woman herself on her thoughts on ABA:

* I feel like it’s worth mentioning that ABA refuses to work on strictly academic skills such as math and science because they are not allowed to according to their insurance policy. At least, this is what we were told by our BCBA.

**ABA operates on the “token economy” system, which is where a client is given a small token such as a star every time they answer a question right; once they have collected enough stars, they can gain a reward, such as watching Youtube videos or playing on the computer, etc.